Bits and pieces: Follow-ups on trans women with prostates, biopsy-free prostatectomies, and more
“Men with prostate cancer?” v. “People with prostate cancer?”
By Howard Wolinsky
The Active Surveillor got a big reaction to the blog post on whether we should drop “men with prostate cancer” and refer to “people with prostate cancer” or “patients with prostate cancer” to be inclusive of transgender women, an admittedly small group that tests our thinking and boundaries.
Everyone agreed on one thing—this is a very “woke” idea. Some took to woke like ducks, and others rejected woke with thunder and fury.
One usual advocate on prostate cancer issues said he wouldn’t touch this issue—and yet he did: “My thoughts on this matter? Not enough to even have a discussion. More people with purple hair and facial jewelry get discriminated against than there [are] transgenders (true transgenders). Discussion over. Sorry if I hurt someone's feelings. I can’t keep up with everyone who chooses to go against widely accepted behaviors and gets their feelings hurt.”
Some thought this was a great idea.
A leader in a national prostate cancer advocacy group told me: “I’m as guilty as anyone of lazily referring to ‘men with prostate cancer and their caregivers.’ At least I’ve progressed beyond assuming that spouses and partners are always women—I have many gay men in my support group. But the issue of transgender women with prostates is an important one.
“Anyway, this is a great and timely piece and an important reminder that we do not live in a binary cisgender world. Thanks for writing it.”
Another participant in groups I help run for, pardon me, people with low-risk prostate cancer, was disappointed in me—though we remain friends in our uncivil society.
He wrote: “I’m very disappointed that you either felt - or were pressured - to join the ‘woke’ assault on common sense, language, and science. A recently reported survey estimated that less than 0.16% of the population was either transgender or, more commonly, men who ‘want to present as women.’ Since this number was created, probably out of thin air, by liberal media sources, the number in this tiny minority is likely much smaller. … here we go, joining the irrational assault on logic by signing on to the insane ‘progressive’ leftist attack on the God-given definition of male and female. What’s next: trying to find ‘men’ suffering from ovarian cancer?
“I’m very dismayed that you have joined this nonsense, Howard. No one gains anything from this sort of surrender.”
I understand. We agreed to disagree. By the way, the numbers I found indicated that there are only 1.2 million transgender men and women in the U.S. Not a groundswell. But to my mind, you can judge us and our society by how we protect the smallest of our minorities.
Let me assure you that no lefty conspiracy leaned on me to bring this up. I just felt that it was high time to discuss this topic.
A European venture capitalist told me that following the article, he had adjusted his pitch on a new diagnostic to accommodate transgender women. “We have now amended any comms [communications] that reference ‘men,’ noting, ‘Throughout this briefing note, ‘man’ or ‘men’ means any individual with a prostate.’"
In this example, it might have been easier to just say “patients with prostate cancer” or “people with prostate cancer.”
Why not sound off in the comments and vote in my Quick Survey at: https://www.surveymonkey.com/r/MQLMFCN.
I only have a tiny sample so far. But 75% are in favor of being inclusive with “people with prostate cancer” or “patients with prostate cancer.” Let’s see how you vote. (Everyone’s ID is confidential.)
By Howard Wolinsky
Inquiring minds want to know, so advertised an infamous supermarket tabloid.
But the readers of TheActiveSurveillor.com also have inquiring minds.
I wrote the other day about a small cohort of German patients who demanded radical prostatectomies without taking the precaution of a biopsy to determine if they qualified for active surveillance, focal therapy, or radiation.
This raised questions among some inquiring minds in this readership. (Thanks Tim, Phil and Bob.)
You itched me so I scratched Valentin Meissner, MD, of the Department of Urology, Technical University of Munich, School of Medicine, who studied the cohort.
One reader asked whether Meissner might have more information on why the patients rushed into surgery. The urologist basically said in an email he didn’t know much.
However, he said several patients were concerned about a biopsy spreading cancer.
“The reasons for not having a biopsy were not assessed routinely, and it was not me who talked to the patients preoperatively,” he said. “However, I had the chance to speak to some patients who refused the biopsy, and one reason that was mentioned several times was that patients were worried about tumor spreading.”
We’ve heard that concern many times. Urologist after urologist has told The Active Surveillor that there is no proof that the spreading tumor “seeds” from a biopsy is a real concern.
Meissner added: “Although the risk of spreading tumor cells seems to be very low and not common in prostate cancer, there are no valuable data available on this issue. Another point was that patients refused active surveillance or other procedures anyway, so for them, the biopsy was regarded as a waste of time.”
Another asked: Could the availability of transperineal biopsies have been a reason? Were these patients worried about sepsis?
Meissner said transperineal biopsies are widely available in Germany. “I don’t think that patients were afraid of sepsis for not having the biopsies,” he said.
The final pathology was revealing and gets to the nitty-gritty for this group: None of the patients was a candidate for active surveillance, Meissner said.
Another reader asked if the fact that the men on average were over 70 was a factor. In other words, had the men reached an age when they felt that the window was closing on surgery.
Meissner rejected that theory: “In Europe, we offer surgery to patients with a life expectancy of at least 10 years. So, age itself is not the main factor, but performance status and estimated life expectancy [are].”
The study suggests that biopsy-free prostatectomies may be a new path for some men.
Do you have any opinions on this? Take TheActiveSurveillor.com Quick Survey: https://www.surveymonkey.com/r/3YBYK6T
Can you help out future patients/people/men/transgender women with prostate cancer and join a webinar at 11 a.m. Eastern U.S. on April 22 for a webinar co-sponsored by a long list of support and advocacy organizations, including the leads, Active Surveillance Patients International and AnCan. (TheActiveSurveillor.com also is a sponsor—see all below:)
Please sign up for the program on the future of AS: "Your Voice in the Future of Active Surveillance," on April 22 at 11 a.m.Eastern/4 p.m. GMT. Register here: https://zoom.us/meeting/register/tJEtfuuqrzwtHNPuqzkigx65YBk8vV-teUdy
Finally, AnCan is holding a webinar on “decisional regret” with low-risk prostate cancer at 8 p.m. Eastern April 6. No registration. Just go to the url below. The program features researcher Chris Wallace, MD, PhD, who also will answer other questions on prostate cancer.
Go to the Barniskis Room: https://www.gotomeet.me/AnswerCancer Or call +1 646 749 3129 Access Code: 222-583-973 (Barniskis Room)
Nothing wrong with 'pregnant people' either, depending upon the sentence, I guess.. It covers anyone pregnant, which is its purpose, and is obviously accurate.
if we reject inclusive but objectively accurate terms, will we then argue for more of our 'own' narrower categorizations, (like we somewhat did in bygone years) by promoting descriptions such as 'pregnant girls' or 'pregnant ladies' or 'pregnant damsels,' etc.
Word usage changes all the time. When it does so for reasons which only benefits others, while remaining accurate, why would we not embrace it?
If 'people' in some cases does sound redundant, then something like 'the pregnant,' 'those who are pregnant,' etc. would be an equally good solution, and in some cases even better, if it flows better in a particular sentence and does not pick on others..
Often there are multiple accurate and objective ways of solving language questions.
Don't fall for the right's trick of categorizing things they don't like as 'woke.'
They know 'woke' is a trigger word; they've made it that way. Then they use it to set up a 'false premise' argument.
'People' is preferred because it's objectively accurate, not because it's 'woke' or promotes an ideology.
No one can argue that 'people' is inaccurate.
Greater accuracy is always preferred.